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-_---- A LIGATION FOR SANITATION PERW I / 4- •-5 <br /> Permit No. _._.. <br /> (Complete in Duplicate) Date Issued ._-GlS� <br /> ___ _--- ----------- ____I_ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> a? -- - <br /> ass JOB ADDRESS AN�LO _ - - -,--p- ..... <br /> - _---------------- <br /> Owner's . <br /> ... ------ ---- <br /> --- -- <br /> Nama ----------_------------ -_---- -------------------------------------- Phone <br /> Address----- -_--- <br /> Contractor's Name - - - ------------ -------- ------ ---.-----------------------------------------------------------._ Phone <br /> ------------- <br /> Installation will serve: Residence [I Apartment House ❑ Commercial jV Trailer Court ❑ Mote ❑ ther ❑ <br /> v. Number of living units: ."+__ Number of bedrooms '-_ Number of baths __:----- Lot size .-...___-- --`I-- <br /> Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand C3Gravel X Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> r <br /> Previous Application Made: (If yes,date--_`"_--,._-_.-) No V New Construction: Yes t< No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> t.a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T Distance from nearest well-----------------Distance from foundation-------------------.Material------------------------------------------------- <br /> No. of compartments-------------------------Size.------------------------....Liquid depth-........ --- -------- Capacity.---------------------- <br /> i <br /> r, Disposal Fie Distance from nearest well .-._.-Distance from foundation_��..._........_Distance to nearest lot I ----A ...._.. <br /> Number of lines----/--------------- Length of each line_C`.'Q___- Width of trench_Aa -_ -- <br /> Type of filter material_J--l---t�Gy�-__Depth of filter material._1_f........Total length_-_-56?------- <br /> � Seepage Pit: Distance to nearest well_,lq.�......Distance fromjou d �.0.._---..Ditar? to nearest IQt ne................. ;+ <br /> Number of pits._-__/__---___Lining material-_ - � ameter.._. ---__-Depth._.i.. _--_-.__-__-_-_-.... <br /> -Cesspool: Dt`sstance f nm oearesfi well________________Distance f om ouni3ation-:.:_--_-_:_._- Ci ing material.-- :-._-__. ------ <br /> lo. ❑ Size: Diameter-------'-----------------------------Depth------------------------------------------------Liquid Capacity--------------------------gals. <br /> Privy: Distance from nearest well._________________--__.-_______._-_--_-_Distance from nearest building------------------------------------------ <br /> L ❑ Distance to nearest lot line-----.----------------------......-----------_------......--_--------------------------------------------------------------------- <br /> Remodeling and/or repairing )describe):-----------------------------------------------------------............. - - ---------`--------`-------------------------------------- 7 <br /> ---------------------------------------------------------_----------------------------------------------------------------------------------------------------------------------------------- .. <br /> LN <br /> .__--------________________._____------.------------------------------------..----------.------------------------------------------------._.........-----------------_-------------.­------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co -_- <br /> unty <br /> Lordinances, State flaws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)- ` ' d_ <br /> f/ -' ------------------------------------- -- -----------------------------------------------------------------------(Owner and/or Contractor) <br /> By:-------------------------------------------------------------------------------'------------------------------------------(Title)------------------- --------- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------------- ---- ------------------------------ DATE-------_----------------------------------------- <br /> Isse <br /> REVIEWED BY-------------------------------------------------------------------...- DATE - <br /> _.------'-- ... <br /> BUILDING PERMIT ISSUED.---.............. - --------------- - DATE----------------6- <br /> 2 <br /> - .............. <br /> Alterations and/or recommendationsc. ------------------------------------------------------------------ -------------_--.................................................... <br /> ser <br /> -------------------- ----------------- .-------" --..- - --- - -------------------------------- - -­----­----------------......................-------------------...... .......-------------- <br /> - '- - <br /> -- - - - --- - - - - - - - ------' -------------------------------------------------------- <br /> FINAL <br /> - ... <br /> --------------- -- L <br /> FINAL INSPECTION BY:------------------------. ._......_-_-------_ Date...----(�--_J`�� <br /> ---------------------------------- -------- <br /> it.. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naselfen Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> 60 Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-59 314 3-'63 F.P.CD. <br />